Department of Medicine

Case Western Reserve University School of Medicine & UH Case Medical Center

The Prophetic Protein :: Who is at risk for heart attack?

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Tense hours in the emergency room while tests confirm a heart attack may be rolled back to mere minutes, thanks to a telltale protein marker identified by Case Western Reserve University School of Medicine researchers. Better yet, a routine blood test for the nefarious protein could serve as an early warning to people at high risk :: Take steps now, and you may dodge the dangerous attack altogether.

When the proverbial elephant takes a seat on one’s chest, it is a decided hint: That person might be having a heart attack, or myocardial infarction (MI). Every 25 seconds, someone in the United States has one, according to the American Heart Association, but the oft-reported sensation of chest tightening or pain is just that-a clue. Even in the hospital, it can take eight to 12 hours for current tests to conclusively rule a heart attack in or out. Common alternative culprits in chest pain are intense heartburn or a gallstone attack.

Led by top physician-researcher Daniel I. Simon, MD, investigators at the School of Medicine, however, have discovered a marker of heart attack that promises to cuthours off the time for definitive MI diagnosis-to the tune of confirmation within 10 to 15 minutes of arriving at the emergency room. What’s more, a simple blood test for the novel myeloid-related protein-8/14 (MRP-8/14) marker could give long-used cholesterol screening a run for its money as a signal of MI in the making, years ahead of the cardiac attack.

“Though we gain great insight into patients’ potential risk for cardiovascular disease using conventional biomarkers, we are limited in identifying some people at risk,” says Douglas Vaughan, MD, professor of cardiology at Northwestern University’s Feinberg School of Medicine and chair of its Department of Medicine. “An additional marker measured in people’s blood could valuably refine our ability to take care of patients with coronary artery disease.”

To hone in on the up-and-coming predictive protein MRP- 8/14, researchers applied an unprecedented scientific approach that scoured entire human genomes for cardiac warning signs. “We were on the hunt. We wanted to know what genes turn on or off in heart attack patients,” explains Dr. Simon, the Herman K. Hellerstein Professor of Cardiovascular Research at the School of Medicine and director of University Hospitals Harrington Heart & Vascular Institute. Dr. Simon and his team of researchers identified MRP-8/14 as their best-bet marker for heart attack for use in emergency settings and as a potential companion to routine cholesterol screening in the doctor’s office.

Dr. Simon’s account is a tale of finding a little molecule with big potential-a project born in a lab in New England that has grown on a campus in Cleveland.

Read the full story at Medicus.

Much-needed complement to cholesterol testing

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For patients outside the highest and lowest traditional risk factor categories, based on factors like high cholesterol, smoking, diabetes, hypertension and family history of heart disease, MRP-8/14 could become a prominent diagnostic tool. “We are attempting to determine whether the use of MRP-8/14 should sway us toward more aggressive preventive therapies,” says Carl Orringer, MD, the Harrington Heart & Vascular Institute Chair in Preventive Cardiovascular Medicine at the School of Medicine.

Currently, a “high-sensitivity C-reactive protein” (hs-CRP) assay is sometimes used in conjunction with cholesterol tests to assess heart disease risk. Like hs-CRP, MRP-8/14 represents a different biological process than cholesterol and is likely to serve as a complement to, not a substitute for, cholesterol screening. Of cholesterol testing’s shortcomings, Dr. Orringer says, “Relying on cholesterol alone is ignoring the inflammation that lights the fuse that sets off the explosion that is the heart ttack.”

Dr. Orringer, who developed an innovative heart attack risk assessment program that uses CT scans to see whether a person has hardening of the arteries, believes that MRP-8/14 may come to be incorporated to aid in risk estimation.

“A person’s heart attack risk is related to how much calcium is in the arteries—the more calcium, the greater the risk,” Dr. Orringer explains. “Those with calcium in their arteries indicating atherosclerosis might be really good candidates for MRP-8/14 evaluation to see who is at the highest risk.”

Director of Institute for Transformative Molecular Medicine, Inaugural Robert S. and Sylvia K. Reitman Family Foundation Distinguished Chair in Cardiovascular Innovation

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Pamela B. Davis, M.D., Ph.D., dean of the Case Western Reserve University School of Medicine, announced the appointment of Jonathan S. Stamler, M.D., as the director of the Institute for Transformative Molecular Medicine and the first to hold the Robert S. and Sylvia K. Reitman Family Foundation Distinguished Chair in Cardiovascular Innovation at the Case Western Reserve University Cardiovascular Center and University Hospitals Harrington Heart & Vascular Institute.

The newly established chair was made possible by a $1.5 million gift from the Reitman Family Foundation and was slated to be held by a preeminent physician scientist dedicated to advancing cardiovascular medicine through compassionate patient care, clinical research, and training of fellows and residents.

As director of the Institute for Transformative Molecular Medicine, primarily based in the Department of Medicine, Stamler will be charged with developing the Institute, with purview across Case Western Reserve University and University Hospitals. His efforts will catalyze scientific discoveries in molecular medicine, formulate new therapies that benefit humankind, and inspire the next generation of physician scientists.

His research specifically has led to elucidating the fundamental role of nitric oxide in control of complex physiological responses through S-nitrosylation, a protein modification that he discovered. His work has helped to transform the simple notion of cellular redox state into the concept of a dynamic and precisely regulated mechanism for control of protein function, analogous to phosphorylation, but operating through covalent modifications at cysteine thiols. The ramifications of his work extend to all major classes of proteins and accumulating evidence suggests that protein S-nitrosylation is aberrant in many diseases.

Stamler completed his undergraduate studies at Brandeis University, earned his medical degree from Mount Sinai School of Medicine, and completed his medical residency and fellowship training in both cardiology and pulmonary medicine at Harvard Medical School and the Brigham and Women’s Hospital. He joined the faculty of Harvard Medical School as Assistant Professor of Medicine in October 1993. In December of 1993, Stamler joined the faculty of Duke University, where he is currently the George Barth Geller Professor of Research in Cardiovascular Disease and Professor of Medicine and Biochemistry.

Renowned researcher to lead transformative institute

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A new initiative in translational research at Case Western Reserve University Department of Medicine and University Hospitals promises to catalyze scientific discoveries, formulate new therapies and inspire the next generation of physician-scientists.

Leading the effort will be one of the school’s newest additions: Jonathan S. Stamler, MD, who will serve as founding director of the Institute for Transformative Molecular Medicine. Dr. Stamler is also the first to hold the Robert S. and Sylvia K. Reitman Family Foundation Distinguished Chair in Cardiovascular Innovation at the Case Cardiovascular Center and University Hospitals Harrington Heart & Vascular Institute.

“This newly established chair in cardiovascular investigation and its relationship to the Institute for Transformative Molecular Medicine will accelerate our scientific research to its full potential and provide new cures and therapies for the patients we serve,” says Richard A. Walsh, MD, physician-in-chief at University Hospitals and the John H. Hord Professor and chair of the Department of Medicine at Case Western Reserve University.

UH received Top Health System Award

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University Hospitals named one of the Top 10 Health Systems in U.S.

For the second consecutive year, University Hospitals (UH) has been named one of the top 10 health systems in the United States based on clinical performance by Thomson Reuters, a leading business and professional information organization.

UH and the other top 10 systems outperformed their peers by a wide margin. They provided better care, followed standards of care more closely, saved more lives, had fewer patient complications, and made fewer patient safety errors.

The list was compiled in a study conducted by researchers from the Thomson Reuters 100 Top Hospitals®. They analyzed the quality and efficiency of 255 health systems based on eight metrics that gauge clinical quality and efficiency: mortality, medical complications, patient safety, average length of stay, 30-day mortality rate, 30-day readmission rate, adherence to clinical standards of care (evidence-based core measures published by the Centers for Medicare and Medicaid Services), and HCAHPS patient survey score (part of a national initiative sponsored by the U.S. Department of Health and Human Services to measure the quality of care in hospitals).

Thomson Reuters rankings are available at www.thomsonreuters.com.

Prostate Cancer at CWRUmedicine

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Worldwide, prostate cancer is one of the most common types of cancer found in men. Learning more about prostate cancer and treatment options can help you and your loved ones take an active part in making choices about care.

* Click here to read about new research conducted by the Division of Hematology Oncology at Case Western Reserve University.

The prostate is a chestnut-sized gland below the bladder, which contributes most of the fluid that combines with a man’s sperm to make semen.

Prostate cancer is the most common cancer other than skin cancer in American men and is the second leading cause of cancer death in men.

The American Cancer Society estimates that more than 234,000 men will be diagnosed with prostate cancer in 2006. Incidence rates for the disease are higher for African-American men than for white men.

Other Prostate Cancer Survivors ::

Harry Belafonte
Musician, actor and social activist Harry Belafonte

Robert De Niro
Actor Robert De Niro

Rudy Giuliani
Former New York City Mayor Rudy Giuliani

John Kerry
U.S. Senator & 2004 Presidential candidate John Kerry

Nelson Mandela
Former President of South Africa Nelson Mandela

First multi-PI combined training program between CWRU and Cleveland Clinic headed by Fabio Cominelli

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Beginning in July, the first multiple-principal investigator combined training program between Case Western Reserve University and Cleveland Clinic will be initiated by Fabio Cominelli MD, PhD, the Hermann Menges, Jr. Chair in Internal Medicine at the School of Medicine, and Claudio Fiocchi MD¸ Clifford and Jane Anthony Chair for Digestive Disease Research and Education, Lerner Research Institute at Cleveland Clinic.
The National Institute of Diabetes, Digestive and Kidney Diseases provided the new joint effort with a five-year grant worth nearly $1M. The funding supports post-doctoral fellows in obtaining digestive disease science training for a period of three years; for physicians this will be in conjunction with their clinical training in gastroenterology.
This training program is unique in that it follows the city-based program model of the Clinical and Translational Science Collaborative (CTSC). Trainees will come to Cleveland with the option to train either at the Lerner Research Institute or the School of Medicine, and they will have the ability to choose among 20 mentors whose laboratories are supported by more than $20 million per year in National Institutes of Health funding.

Ohio Senate grants letter of commendation to School of Medicine

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The members of the Senate of the 128th General Assembly of Ohio paid tribute the School of Medicine in an official letter of commendation for being ranked as the 20th best medical school in research in the nation, as ranked by U.S. News & World Report.

The letter praised our institution, “known for its dedication to medical research, and the world of its highly qualified and committed staff has earned the university an exceptional reputation.”

Signed by Senator Bill Harris, President of the Ohio Senate, and Senator Shirley A. Smith, Assistant Minority Leader, the acknowledgement applauds the School’s innumerable contributions to the study of medicine.

Congratulations Class of 2010

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On May 16, Case Western Reserve University School of Medicine had the privilege of graduating 157 of its best scholars into the world as physicians.

The well-rounded Class of 2010 has attained intellectual mastery of the Western Reserve  curriculum and matched to some of the finest residency programs in the nation. These new physicians are well-prepared to practice medicine.

It is the hope of the Department of Medicine that they fulfill their dreams while continuing the rich, long-standing Case Western Reserve tradition of medical excellence.

Congratulations and many thanks to the professors, instructors and staff that helped guide the students through their journey and shape their experience here in Medicine.

University Hospitals Case Medical Center Earns Prestigious National Award for Excellence in Delivering High-Quality Care

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University Hospitals (UH) Case Medical Center is one of five academic medical centers in the nation to receive the 2009 Quality Leadership Award from the University HealthSystem Consortium (UHC). The prestigious award is given to teaching hospitals that demonstrate excellence in delivering high-quality care, as measured by the UHC Quality and Accountability Study conducted annually since 2005.

This year, 93 member hospitals were ranked by UHC, a national organization representing more than 90 percent of the nation’s nonprofit academic medical centers. UHC’s distinctive study measured hospitals’ performance using the Institute of Medicine’s six domains of care—safety, timeliness, effectiveness, efficiency, equity, and patient centeredness.

“We are proud of this extraordinary achievement which reflects University Hospitals’ ongoing commitment to quality and safety for our patients,” said Fred C. Rothstein, M.D., President of UH Case Medical Center. “This is an exceptional recognition when you consider that academic medical centers across the country participated in the survey.   We are pleased that the excellence of our health care providers and staff was recognized by this prestigious organization of peer institutions.”

“National recognition is well deserved for these organizations that have distinguished themselves as high-performing organizations in a complex environment. I salute the top performers and extend congratulations to all academic medical center leaders and employees who daily demonstrate a passion for improving patient care and operational effectiveness,” said UHC President and Chief Executive Officer Irene M. Thompson.

UHC examined data provided by member hospitals through its comparative clinical, operational, and core measures data bases and reviewed additional source data from the publicly reported Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

Other hospitals recognized this year in addition to UH Case Medical Center:

  • Methodist Hospital—A Clarian Health Partner, Indianapolis
  • Rush University Medical Center, Chicago
  • University Medical Center, Tucson
  • The University of Kansas Hospital Authority, Kansas City

“As an organization, UHC is committed to improving members’ performance. Through this study, we are able to determine what structures and practices are associated with excellent performance across an AMC,” said Mark Keroack, M.D., M.P.H., Chief Medical Officer and Vice President of the UHC Clinical Practice Advancement Center. Dr. Keroack, with others at UHC, developed the study approach and has conducted several organizational development workshops for UHC members across the country.

He is the lead author of “Organizational Factors Associated With High Performance in Quality and Safety in Academic Medical Centers,” published in the December 2007 issue of Academic Medicine. The critical success factors first identified in that study are a shared sense of purpose throughout the organization, leadership style, an accountability system, a focus on results, and a collaborative culture.

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